Healthcare Provider Details

I. General information

NPI: 1295893220
Provider Name (Legal Business Name): GRAVETTE MEDICAL CENTER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

IV. Provider business mailing address

PO BOX 450
GRAVETTE AR
72736-0450
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5291
  • Fax: 479-787-7890
Mailing address:
  • Phone: 479-787-5291
  • Fax: 479-787-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR4284
License Number StateAR

VIII. Authorized Official

Name: MR. WILLIAM SPARKS
Title or Position: INTERIM CEO
Credential:
Phone: 479-787-5291